A Thorough Checkup

GOOD HEALTH Dr. Paul Donohue

Dear Dr. Donohue: I would like to know just what steps should be taken by a physician in order to give a patient a thorough physical checkup. Could you outline the necessary steps? _ M.S.

Dear M.S.: Much depends on the patient's age and whether the patient is new to the doctor. Let's take a hypothetical 50-year-old on his or her first visit to a particular doctor.

The most important part of the exam is a medical history. To determine that, the doctor probes all aches and pains from head to toe. The doctor also inquires about illnesses that run in the family, and seeks a list of all the patient's important past ailments.

Then comes the physical exam. The entire body is inspected, palpated and listened to, when necessary, with a stethoscope. Heart, lungs, abdomen and blood vessels are targets for stethoscope listening. As banal as it sounds, recording height, weight, blood pressure and pulse is an integral part of the physical exam. For men, a rectal exam and finger probing of the prostate gland are necessary. For women, a pelvic exam along with a Pap test and a rectal exam are essential.

For men older than 50, many doctors routinely order a prostate-specific-antigen blood test. An eye examination, in which the doctor peers into the eyes with a bright light, should be routine, as should be a check for glaucoma. Inspection of the ears and a simple hearing check should be included.

Recommended laboratory tests include a urinalysis and a blood count. Often a battery of tests for such factors as cholesterol, liver enzymes and blood sugar is done on a single sample of blood. The stool should be tested for hidden blood.

Dear Dr. Donohue: Recently a longtime friend passed away. His doctor said the cause of death was a lack of blood to the intestines. In over 70 years, I have never heard of that. Will you elaborate? _ M.E.N.

Dear M.E.N.: It's not as uncommon as you might think. It's called ``intestinal ischemia.'' Ischemia is a lack of blood supply. A lack of blood supply to the heart is cardiac ischemia.

Both cardiac and intestinal ischemia stem from the same process: obstruction of blood flow through arteries clogged with cholesterol and fat. If the blockage is complete in heart arteries, the result is a heart attack. In the intestines, the blood-deprived section dies, releasing bacteria into the abdominal cavity. Even with emergency surgery to repair the involved section of intestine, death is an all-too-common outcome.